Vertical rectus muscle augmented transposition in Duane syndrome

Introduction: Reduction or elimination of face turn and esotropia in the pr imary position while maintaining the largest possible diplopia-free field a re the major surgical goals in Duane syndrome with esotropia. Unsatisfactor y postoperative results may occur because of limitation in adduction, poor abduction, or induced vertical deviations. Recent reports have shown enhanc ed results from rectus muscle transposition techniques when a lateral poste rior augmentation fixation is placed. Methods: Preoperative and postoperati ve data of 2 groups of subjects who had Duane syndrome with esotropia in pr imary position and markedly reduced abduction were comparatively analyzed. Group A consisted of subjects who had transposition of both vertical rectus muscles to the lateral rectus muscle with a posterior lateral augmentation suture placed in each transposed muscle. Group B subjects had transpositio n of both vertical rectus muscles to the lateral rectus muscle without the posterior lateral augmentation suture. Results: A total of 32 subjects in g roup A and 22 subjects in group B were analyzed. In group A, anomalous head position improved 19.1 degrees +/- 10.3 degrees compared with group B subj ects who improved 10.6 degrees +/- 5.8 degrees (P<.05). In group A, esotrop ia in primary position improved 16.4 +/- 9.2 PD compared with group B subje cts who improved 8.5 +/- 6.9 PD (P <.05). Conclusions: Subjects with Duane syndrome and esotropia in primary position who had undergone augmented tran sposition of the Vertical rectus muscles obtained improved head position an d better alignment in primary position and had a reduction in the incidence of reoperation for undercorrection when compared with similar patients who had undergone vertical rectus muscle transposition without posterior later al augmentation sutures.